The hypothesis that drug withdrawal delirium was related to a gross disturbance of sleep and a marked excess of REM sleep, suggested that drugs used to treat delirium should depress REM sleep. Chlormethiazole in doses over l g was found to be effective in depressing REM sleep and in blocking the REM sleep rebound when sodium amylobarbitone (400 mg) was stopped abruptly.

During a psychiatric survey in Sarawak, subjects demonstrating latah were examined separately, both clinically and with a questionnaire. Latah occurred only in females, mainly Malays, occasionally Ibans, and never Chinese. Fifty latah subjects were examined, seven were firmly diagnosed as being mentally ill, and another 13 demonstrated mild psychiatric disorders. Dream content indicated an overt sexual component.

Eight phobic outpatients were treated by six sessions of desensitization followed by exposure or vice versa. Treatment was by visualization of phobic images up a hierarchy for 20 minutes at a time. During desensitization patients were relaxed before and after each image, while during exposure they looked at a neutral slide instead. Skin conductance activity was significantly lower during relaxation than during observation of the neutral slide. The patients, therapist, and a ‘blind’ assessor rated the main phobia as significantly improved for both treatments together. Each of the two treatments contributed similarly to improvement during and after treatment sessions, on measures of main phobia, subjective anxiety, and heart rate. Relaxation training appears to be redundant to the desensitization procedure.

A study is reported of a random sample of 170 normal men and 192 normal women who were given a 110-item questionnaire incorporating items intended to measure personality variables P (psychoticism), N (neuroticism), E (extraversion), and L (a lie and dissimulation scale). Factor analysis of the intercorrelations between items disclosed a clear-cut psychoticism factor, relatively independent of the others. The rationale and the psychiatric importance of this factor are discussed.

The concentration of cortisol (F) has been found to decrease only to a limited extent in intact brain tissue maintained at ambient temperature after death, and the decrease is mainly accounted for as 20-dihydrocortisols (DHF). The sum of F and DHF has therefore been estimated in samples of frontal cortex removed from human cadaver brains collected at necropsy, and taken as a measure of the concentration of cortisol at death. Corticosterone concentration was also estimated. The concentration of cortisol in the cerebral cortex of physically healthy individuals who had committed suicide was consistently as low or lower than in the cortex of control patients who had died suddenly without antecedent severe illness. It is concluded therefore that neither the presumed severe emotional stress preceding suicide nor depressive illness itself is associated with high levels of cortisol in the cerebral cortex. On the other hand, it was found that the cerebral cortical concentration of cortisol in patients who had died from stressful somatic diseases was raised and that the increase was roughly related to the likely degree and duration of the physical stress endured by the patients. There was some indication that the ratio of cortisol (F+DHF) to corticosterone may be lower in the cerebral cortex of suicides than in that of controls.

The study aims to determine (1) the extent to which parental social class influences the incidence of early parent death; (2) the effect of parental social class on the outcome of early parent death, in terms of vulnerability to adult mental illness; (3) whether early parent death affects the age of terminating full-time education; and (4) whether early bereaved subjects lag behind their non-bereaved contemporaries in social class status. The study shows that parental social class does influence the outcome of early parent death and that early bereaved subjects do lag behind in social class status.

SYNOPSIS Skin melanin concentrations were measured by reflectance spectrophotometry in patients during the active phase of a primary affective illness and in normal subjects. There were no significant differences between 27 females with depression (unipolar illness) and 17 females with mania (bipolar illness) or between a mixed group of 30 male patients with mania and depression (predominantly mania) and a normal sample of 27 male subjects. These negative results are discussed in terms of the catecholamine hypothesis of the affective disorders. A study of brain pigmentation is suggested as being a potentially useful investigation in manic-depressive psychosis.

The relationship between the affective connotations of material and the ease of its recall two weeks later has been examined in a group of psychiatric inpatients suffering from affective disorder. The tendency to recall more pleasant than unpleasant material has been less marked in patients showing overt depression than in patients who were hypomanic or recovered from depression at the time of the experiment. This has been chiefly because of the higher negative tone of recalled material in the depressed patients. Other attributes of the material, relative to its impact on the subject, have also appeared to be less influential in recall in the presence of depression.

In order to test two theories of the mode of action of imipramine 58 depressive patients were treated at two dosage levels with desmethylimipramine (DMI), its active metabolite. Clinical judgments were used to distinguish therapeutic responders from non-responders, who showed clear differences in depressive rating scales and body weight changes. Measurements of urinary output of DMI, of salivation, and of the incidence of side-effects were compared in responders and non-responders: no differences appeared between the two groups. It is concluded that the therapeutic effect of imipramine does not depend on either its anticholinergic or other action revealed by the common side-effects, and that variability of response cannot be accounted for by differences in the rate of metabolism of DMI.

Cloze procedures using fifth and fourth word deletions were compared for schizophrenic and non-schizophrenic speech transcripts. Both methods distinguished between the schizophrenic and non-schizophrenic speech. Fourth word deletion gave lower scores overall and this effect was significantly greater for the more disorganized schizophrenic speech. An encoding deficit involving inappropriate repetition is discussed as a possible explanation for the findings.

During 20 separate illnesses 17 severely disturbed manic patients were given either methysergide or thioridazine in a 21 day double-blind controlled trial. For most of the trial patients received either 9 mg methysergide or 450 mg thioridazine daily; during one 24-hour period 12 mg methysergide or 600 mg thioridazine was administered. Daily clinical assessments were made. Methysergide proved significantly less effective than the phenothiazine.

Two adjacent areas of Greater London are compared to determine their respective use of psychiatric beds of different types. The one-day census is shown accurately to reflect average bed use in any year. The areas and hospitals involved employed different community and social work policies. A difference emerges in the use of long stay beds. A community-based social work service appears to make little impact on the use of short stay beds, and appears less successful than a hospital-related service in preventing hospital chronicity. Community social work services may identify psychogeriatric patients requiring hospital admission.

A male patient is described whose loss of sexual interest and activity was due to gonadal failure, presumably the result partly of Klinefelter's syndrome and partly of orchitis, though the latter was unilateral. He showed no change during a placebo control period, but within a few days of starting replacement treatment with testosterone he reported a return of sexual interest and showed a response to sexually arousing stimuli; sexual attitudes also improved. This case is of interest because of the specific and rapid psychological response to the correction of an androgen deficiency.

Patterns of child guidance referral and of juvenile delinquency in a metropolitan borough were examined in relation to neighbourhood and school. The two sets of rates showed similar trends among 20 electoral wards, both being related to socioeconomic indices. They also varied widely among the 100 schools in the borough, being higher for schools of low privilege in the educational system. The school rates appeared to vary independently of neighbourhood effects.

Three hundred and six male subjects in a community survey reported on their ‘motivation for drinking’. Factor analysis revealed three major factors. Factor 1 relates to N (neuroticism) score, more extreme drinking, and likelihood of drink-related trouble. Factor 2 is associated with more privileged and factor 3 with less privileged class status.

A double-blind comparison was made of the effects of amantadine hydrochloride, orphenadrine hydrochloride, and placebo in the control of the effects on the extrapyramidal nervous system of fluphenazine decanoate. Patients were assessed with regard to the main symptoms of Parkinsonism, the leading clinical signs, performance in walking, writing and squeezing, changes in mood, and unwanted effects of medication. Neither of the pharmacologically active substances was superior to placebo. Attention is drawn to the paucity of evidence for the effectiveness of anti-cholinergic drugs in both Parkinson's disease and in drug-induced Parkinsonism. The special difficulties in performing trials of substances used in relieving the unwanted effects of other drugs are discussed in relationship to defects in methodology in both this and earlier trials. The findings of the present study are not conclusive but show a clear need for further research in this field. The possible theoretical and practical importance of such research is discussed.

A factor analysis was carried out of ratings on the Hamilton Scale on a group of 134 male and 213 female depressed patients. The original data covered a wide range of severity of illness and the distribution of severity scores was not biased from normal. Hamilton's general factor was confirmed but his bipolarity between agitated and retarded depression did not emerge. Sex differences in factor patterns were found and a preliminary experiment showed that factor scores could isolate anxiety features and personality factors.

Based on the available research evidence, several rating and self-rating methods are recommended which appear to be suitable for the measurement of changes in distress in drug trials with neurotic patients.

What sort of animal is a ‘research unit’ supposed to be? At one extreme it can see itself as a collection of workers each pursuing his own bent, and who just happen to lodge in the same building. The opposite would be a unit dedicated to rigidly programmed research.

SYNOPSIS Experimental data on the location in the brain of electrode sites supporting electrical self-stimulation are reviewed. All previous studies are in agreement that the behaviour is most easily elicited from lateral hypothalamic sites corresponding approximately to the fibre pathways known as the ‘medial forebrain bundle’. Some brainstem electrode sites will support self-stimulation. Experiments are summarized which indicate that there is a correlation between the sites of electrode tips positive for self-stimulation and the location of catecholamine-containing neurones in two regions: (1) in the region of the dopamine-containing cells in the ventral mesencephalon (cell-body groups A9 and AIO of Dahlstr¨m and Fuxe, 1964), and (2) in the region of the noradrenaline-containing cells of the locus coeruleus (A6 group). These two cell-body groups give rise to axons which pass through the medial forebrain bundle to form terminal systems with a widespread distribution in the prosencephalon. The hypothesis is advanced that electrical self-stimulation results in the majority of cases from activation of one or both of these catecholamine-containing systems.